Plasma Concentrations of Diltiazem and Desacetyldiltiazem in an Overdose Situation

Abstract

Survival following massive diltiazem overdose can be achieved with supportive care. Charcoal hemoperfusion had a limited effect on improving the clearance of diltiazem as evidenced by serial plasma concentrations.

Massive diltiazem overdose treated with extracorporeal membrane oxygenation

“…Both atropine and isoprenaline did not prove useful in treating bradycardia after the onset of atrial standstill. Glucagon has traditionally been indicated to treat hypotension and bradycardia in CCB overdose (1,10,12,14). The efficacy of glucagon in this case could not be ascertained because it was used in conjunction with other inotropes.…”

“…Maintenance of circulatory function with supportive therapy is the most important factor in the management of patients with CCB overdose in which intact survival is possible despite profound cellular and cardiovascular compromise (1)(2)(3)(4)(5)7). Because of DTZ's pharmacodynamic properties and high degree of protein binding, no treatment methods are available that hasten its detoxification once the drug has distributed into the tissues.…”

“…M assive calcium channel blocker (CCB) overdose traditionally carries a very high mortality, yet survival with a good outcome may occur despite evidence of profound cellular toxicity (1)(2)(3)(4)(5). We discuss the exceptional survival of a patient in whom toxicity from sustained-release diltiazem (DTZ) overdose was particularly extreme and prolonged, resulting in a number of unusual features previously unpublished.…”

Lessons learnt in the pharmacokinetic analysis of the effect of haemoperfusion for acute overdose with sustained‐release diltiazem

“…The semi-logarithmic concentration-time disposition curve for our patient is compared to that of other survivors in the literature in Fig. 2 [5,6,[17][18][19][20][21][22][23]. The pharmacokinetic profile following ingestion of the sustained-release formulation appears biphasic.…”

“…Extracorporeal enhanced elimination was trialled in each patient ingesting a sustained-release product (HP [5,17,23] or Molecular Adsorbents Recirculating System (MARS; albumin dialysis) [22]) which on visual assessment did not substantially alter the pharmacokinetic profile. Given the small number of patients and variable duration of sampling (generally longer in sustained-release, presumably due to prolonged admissions) this apparent observation cannot be readily confirmed and more data is needed.…”